Where to start in managing diet problems

Speaking to your doctor, dietitian or specialist nurse can be the start of getting help.

What you can do

One of the ways you can help yourself is by keeping an eye on your diet problems. You should let someone know if:

  • you have lost your appetite
  • you feel sick
  • you are in pain
  • you worry about your weight

Use the support available to you. Ask questions and get your doctors and nurses to explain things to you in simple terms.

You will cope better with your situation and improve it if you understand your diet problems. 

Who to talk to about your diet problems

Speak to your doctor, cancer nurse or dietitian if you have a problem with diet, digestion or weight loss.

Your doctor will most likely refer you to the hospital dietitian for help. Many cancer units and hospitals now have dietitians for people with cancer. They work with your doctor to decide together on the best way to manage your diet problems.

Other people who can help support you to manage your diet problems include:

  • your family and friends
  • specialist nurses
  • social workers
  • religious or spiritual leaders

How specialists can help you

Specialists can help you with your diet problems in the following ways:

Your specialist cancer doctors and nurses are there to help you. They have the skills to treat all problems related to cancer and treatment. Your GP will also be willing to help.

Take your diet problems to whomever you feel most comfortable talking to. They work as a team and will pass on any information about your diet problems.

What they suggest will depend on:

  • any treatments that you are having
  • how long you have had the problem
  • how bad it is
  • what is causing it
  • if the problem is likely to be temporary

Dietitians play an essential role in helping you with diet problems. Most cancer hospitals have dietitians. They have the training and skills to look after people with cancer. They can answer your questions and help you deal with any problems you have with eating.

They can suggest specific meals, snacks, and food. They can also tell you how to prepare food to help you eat. For example, a pureed diet may help if you are having problems swallowing.

Your dietitian can also plan a special diet to make sure you get all the calories and nutrients you need.

They may suggest special drinks that can replace a meal if you can't face eating. You can buy the drinks from a chemist, or they are available on prescription. There are many other types of nutritional supplements. They can help to boost your intake of nutrients. Your dietitian can tell you more about these.

Your dietitian will see you regularly if you have a more severe problem and need drip or tube feeds.

They can also help arrange for any cultural or religious dietary needs while you are in hospital.

A pharmacist checks that the type and dose of any drug prescribed for you are safe. They will check how safe it is for you to take drugs that help with eating and weight loss with your other medicines. They will also make sure it is safe to take with tube feeds.

Speech therapists help people with speech problems. They also help people who have difficulty swallowing. This can be after surgery or radiotherapy to the head and neck area. It can also be due to cancer itself.

They assess you and tell you about the right texture of food or fluid to help you swallow safely.

Nutritionists can sometimes give useful help and advice during your cancer treatment.

A nutritionist is a health specialist who knows about food and nutritional science. They also know about using nutrients to help people recover from illness. Nutritionists have different levels of education. It varies from little education to a bachelor's, master's or doctoral degree.

The term nutritionist or nutritional therapist is not protected by law. That means anyone can use it. Nutritionists don't usually work in the NHS, although some might work alongside dietitians.

Others work in non clinical roles in the government, food industry, research, teaching, sports and exercise settings. You usually pay for their advice if you see them privately.

It is important to check that you see a trained nutritionist. You can do this by contacting The Nutrition Society.

Assessing your dietary needs

Before your doctor and dietitian can do anything, they need to know about your illness and diet. They will ask you a lot of questions about the history of your illness, your appetite and weight. This is called a nutritional assessment.

This may seem like too much to deal with if you are very tired, weak or sick. But your doctor and dietitian must assess you. By understanding your diet problems, they can offer you the right treatment.

Your doctor will examine you and might arrange for further tests.

Below are some of the questions your doctor might ask.

  • What is your normal weight?
  • Have you been on any type of diet or lost or gained weight over the past 6 months, and if so, how much?
  • What do you eat in a typical day and has this changed over the last 6 months?
  • Do you ever have diarrhoea or constipation or feel sick or vomit?
  • Have you lost your appetite?
  • Do you have any problems with eating, such as a sore or dry mouth?
  • Does food taste any different to you since you were diagnosed with cancer?
  • Do you have problems with swallowing or chewing?
  • Do you often feel tired or dizzy or confused?
  • What medicines are you taking?

Your doctor and dietitian also consider any other medical conditions you have. A condition such as diabetes may affect your nutritional needs.

After your nutritional assessment your doctor will examine you. This involves checking your body for signs of poor nutrition, including:

  • examining your tummy area, mouth (gums and tongue) and skin
  • taking your blood pressure and pulse
  • checking your weight
  • looking for loss of fat and muscle tissue
  • looking for signs of dehydration (dry skin, thirst, low urine output) or fluid build up (swollen ankles or abdomen)

You may also have urine and blood tests. This will give your doctor more information about your body and how it is absorbing food. But a detailed history of your diet and weight often tell more than laboratory tests.

UK guidelines about patient nutrition

The National Institute for Health and Care Excellence (NICE) has guidance on support with nutrition for adults. This guidance says that patients should have screening for signs of malnutrition. Screening should also assess if they are at risk of becoming malnourished. 

This screening should happen on admission to hospital. Or at your first outpatient appointment. 

The screening involves:

  • checking your body mass index (BMI)
  • assessing weight loss
  • looking at risk factors for malnutrition

The assessment aims to make sure people get the help they need. This helps them recover quicker from their illness and treatment.

For general information and support, you can contact the Cancer Research UK nurses on freephone 0808 800 4040 from Monday to Friday, 9am to 5pm.

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